| NPI | 1790235968 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THEUS WESLEY ROGERS Doctor 706-321-9800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA 1518) |
| Enumeration Date | 2016-10-11 |
| Last Update Date | 2016-10-11 |